HomeMy WebLinkAboutPermit Building 1988-5-13
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I INSPECTION LINE
726-3769
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CITY UF SPRINGFIE~D
COMBIIIATlON APPLlCATlONfPERMIT
EilERGY SOURCES:
Heat~ 1"VAc:.
Hater Heater~~~
Range
ValuE of Hark:
~g9~. .,.~
BuiltiinQ Permit Info: Describe Work(i~e," Build Single
Familv Residence With Attached Garaae)
~~~./""',,""H' ~F &,A,;"'~ _~7....~
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Job Address 1RB7 ~...._c..,. ~M"IM"_ E~r
Legal DescriPtion/?~~.2~_:Z3 /9~. '2~ ?/~
Owner JhU:.AdA?-N ~?~#'ES ./K;y.
Address.Q 1U ,.,. " -r-.-. ~~oj(.~ //SIli>
./"".::> ;v. /""""'~k/.v /'5. L/;r. "'~-flL"'.:
~~.b ..LP7i'. 97'</7
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Construction lender
INFORllAT/OH llN<
726-3753
Sq. Ftg. 1'lain~2 If"
~q. Ftg. Access.
Sq. Ft9. Other
)( flew Add A Iter Rep.
-Fence 0"" ChangefUse
XOther~~~
Address Phone
Ut:.~lliN n.Af.' (name) (address) flies. no.l (exoires)
Primary ~'dn #~".,,-:^" ?~~. /'2::ZcP A( ~~#77€.N ~;. ~~
Structura 1
Electrical
Mechanical
CONTRACTORS (name) (addres~;) nir:s. no") (pxnirpd
GeneraIM.c~<9Y2r&; ~J._...~~,........ C':'~.~.,.. Jv. '2'~G~~
Plumbino~N J?~( 7?z:i'/-..k- ""'U'~~ w: 7?~",,_. &.$.-'.rs:
I _ . , _ _ ,
,E1ectr;calL.~ 1?~~"""")'/~~. /4ZJV~./ ,,>o,..y......~~. :5~/~.c::>"
'1echani~al /lJ9.7t1l'E"7' ..{ ~/~ ~ . ~~ ~~~r 0-y-
,
NO.
-:2
Each single fixture
PLU1IBING
FEF rHARr.F
Nn
7.S"6 IS--
Residence of
Relocated building
(new fix. additional)
~ New circu!ts alts.
or extens10ns
~ <'R. ~6
SERVICES
S.F. Residence
(] bath \
Duplex (1 bath) each
Additional bath
\>later service
Sewer
Storm Sewer
ELECTRICAL
~
~
VJ
(ohona no. ~
~..2.2S"'~.
(ohnnp M, \
~~7/~~
r-: R":? -/4//~
~.7-6~~
7~- /~:2/
MECHANICAL
1IL.J:I!AB.IiE.J:JO.....I
furnace/burner to
/ BTU'
H.U~ "..1"-'.. ~
Floo'r furnace
and vent
SQ. FT.
-z:;z.5&
I ~I='I='
IrHt"RliE,
~-
Recessed wall
~n~rp hp~tp~ ~nrl vpnt
Appliance vent
"~D~r"'tp
Stationary evap.
cooler
Vent fan with
"inole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hond and durt
Temporary Construction
Change in existing
re~ j ctrJ'lCP
multifamily, camm. or
Tnctu<:.tr;al
:5.-
COMI.I. {I ND. FEEDERS
I Install/alter/relocate
,cti<:.trih fppnpr<:.
Wood stove/heater
....... 6A'5" P~nz;,
.::<'--
TypefConst.~ ~Uni ts
"
Bedrooms Occy Load
Stories / Occy Groupfi'-:z
<0-:;-.0
---~ ----
-:7 S''3
_ __..LS: ~___
-75
____f'S'= --
-::? . -::z5'
__nLS:_~__
. ?S"
Plan Ck. Commflnd
65X/Bld~ P~r Fp~
Plan Ck. Res
30%/Blda Per Fee
Fence
J
Of
/
amps.
~-<-~
ISSUANCF OF PFRllIT
,
x
x
TOTAL CHARGES /!?- ....... TOTAL CHARGES ~<:. ...... I TOTAL CHARGES ~# /--;;:.-.
WHERE STATE L'\/ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed application for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of OrelJon pertaining to the work described herein. and that rw OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Bui1der1s
Board is in full force and effect as required by ons 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7111.055 will pd on this.-project. .
IlAI.IE(please print) ~ 0/.J~et'-. SIGNATURE ~ //~~~ DATF ~;.B~
FOr. OFF I CE USE DIllY
Sq. Ftg. riain-0/2.o?
Sq. Fta. Access
Sq. Ftg. Other
BUILDING PERNIT
Charges and
Surcharges
PLUl1BING PERMIT
Charges and
Surcharges
ELECTRICA~ PERil IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
IOf
I
I
I
DURIO
Sidewalk
AfC Pavi ng
Curb Cut
amps.
Value
Value
Value
ij'~--~- ~
Zone LL
Fi re Zone
Flood Plain
TOTAL VALUATION
'":h. //,y~.;~:> d.'!!.
la--> -= 'syste. ms Development ~"...........
r~.6-:> Charae (!.5~~ <C;"..O>'=
I
I
,-I
I
Total Comb. Permit
TOTAL
/3/. ?8
I
:/s<.~r
'_.
.,
,.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100. Lane County Map Reference
II oj 43 .
2. exa~le- Lot I. Block 3, 2nd Addition to
>prlngtield Estates .
C. Name, etc. of owner and construction lender
O. Energy Sources
1. exam~le- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electr;cal/or solar
E. Square- footage or valuation, etc. -
I. examole- 12S0 sq. foot house, SOO sq. foot garage
2. example- if new project, check-nfw - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
3. exa~le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAll ANO CONTRACTORS
To ~void design or construction delays. Building
Division Staff must be able to contact appropriate
pe~sons regarding design information or job. site
corrections, etc. .
II.. Abbreviated Plumbing, Mechanical, & Electrical Schedules'.
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To'conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
th~ abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDOLES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
J (s:-(
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V. FOR OFFICE USE ONLY
Permit Clerk
?-~
. PROJECT CONDITIONS TO BE SATISFIED 8EFORE OCCUPANCY:
Permit applicant exempt from registration with the 8uilder's Board because:
Additional Project Information:
.. ,
PLANS REVIEWED 8Y:
name' L.1J}f?NE X. c,;-t!j e?>
signature
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date ,~-#~
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or
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